Clinical Practice Guidelines for Recall and Maintenance of Patients with Tooth-Borne and Implant-Borne Dental Restorations

Prosthetic complications and survival rates of metal-acrylic implant fixed complete dental prostheses: A retrospective study up to 10 years

STATEMENT OF PROBLEM

Long-term data are sparse on the use of metal-acrylic resin implant-supported fixed complete dentures.

PURPOSE

The purpose of this retrospective clinical study was to assess the prosthetic survival and complication rate in patients treated with metal-acrylic resin implant-supported fixed complete dentures (ma-IFCDs).

MATERIALS AND METHODS

The patient record system at the Dental College of Georgia was searched from 2006 to 2020 to identify all patients treated with ma-IFCDs by the graduate prosthodontic and general practice residents during this time. Variables collected were date of delivery of the prosthesis, arch treated (maxilla, mandible), date of the last visit, status of the opposing arch (complete arch fixed implant-supported prosthesis, complete denture, removable implant-supported overdenture, teeth and removable partial denture, teeth and implants, teeth only), date of replacement, and reason for replacement. Reasons for replacement were grouped as fracture of the framework, implant loss, patient-related concerns, catastrophic acrylic resin fracture (judged to be beyond predictable repair by the clinician), and extensive occlusal wear (judged to have worn to the point of requiring replacement).

RESULTS

A total of 84 arches in 55 patients who met the inclusion criteria were identified from the electronic health review. Of the 84 complete arch prostheses, 43 were maxillary and 41 were mandibular. The median follow-up time was 2.8 years (interquartile range [IQR] 0.95, 4.65). A total of 31 of the 84 arches were identified as having failed, requiring replacement. The most frequent reason for replacement was catastrophic fracture of the acrylic resin (61%), followed by excessive occlusal wear (19%). It was found that 13% of the failures were associated with patient-related concerns, and 7% with the loss of an implant. Survival rates were analyzed based on the opposing arch. The combined survival rate (Kaplan-Meier, log-normal modeling) for ma-IFCDs was 54% at 5 years (95% confidence interval [CI] 42%, 66%) and 32% at 10 years (95% CI 20%, 47%).

CONCLUSIONS

Mid- to long-term survival rates for ma-IFCDs are concerningly low. The findings suggest that the status of the opposing arch plays a role in the survival rate of ma-IFCDs. The most common complication was catastrophic fracture of the acrylic resin superstructure, followed by wear of the acrylic resin denture teeth.

Maintenance protocols for implant-supported dental prostheses: A scoping review

STATEMENT OF THE PROBLEM

Biological complications of implant-supported prostheses remain a concern. Therefore, standardizing hygiene protocols to promote their maintenance is important.

PURPOSE

The purpose of this scoping review was to identify available hygiene guidance for home care procedures, as well as periodicity and protocols for the professional maintenance of implant-supported prostheses.

MATERIAL AND METHODS

This study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the study protocol was made available at: https://osf.io/5jdeh/. The search was last performed in the PubMed database on March 15, 2022 and was undertaken by 2 independent researchers. Clinical studies and reviews that evaluated home care and maintenance protocols for dental implant-supported prostheses (fixed or removable), without language restriction or year of publication, were included. A descriptive analysis was performed considering study characteristics (study design, restorative assembly, maintenance strategies, eligibility criteria, number of included studies, quality/level of evidence, and main findings).

RESULTS

The initial search yielded 3138 studies, of which 18 were included for descriptive analysis (6 critical reviews, 4 clinical trials, 3 systematic reviews, 2 guideline reports, 2 retrospective studies, and 1 transversal study). The main instrument recommended for home care was the use of a conventional toothbrush associated with triclosan-containing toothpaste in addition to interproximal aids (brushes or floss) for all types of restorations. The use of irrigation instruments was also frequently considered. For professional maintenance, almost all studies reported a positive effect of regular recalls every 3 months during the first year, followed by less regular recalls according to the motivation of the patient and home care efficacy. At each recall, the professional should evaluate the patient history, oral tissues, implant, abutments, and restorations, as well as perform professional cleaning of the prostheses with appropriate instruments so that the implants and abutments may be preserved.

CONCLUSIONS

Establishing an adequate hygiene protocol is indispensable for implant-supported restorations. To do so, the professional must guide and support the patient's home care by taking into account the patient's motivation and efficacy during the hygiene procedures. Also, for professional maintenance, the periodicity of recalls should be constant and include an evaluation of the condition of the restoration and adjacent tissues, followed by professional cleaning of prostheses, implants, and abutments, in addition to new instructions to improve patient home care.

Assessing the quality of YouTube™ videos on fixed dental implant home-care and maintenance protocols

OBJECTIVES

The implant's supporting structure differs from that of the teeth when plaque accumulates, making it more prone to inflammation and bone loss. To ensure the implant's longevity, an effective maintenance protocol should be followed. This study aimed to evaluate the information on oral hygiene procedures at home for implant-supported fixed prosthesis.

METHODS

The keywords 'cleaning dental implant,' 'how to clean dental implant,' and 'dental implant hygiene' used to search for videos on YouTube™. Following the exclusions, two researchers independently analysed the remaining 100 videos for demographic data and content usefulness.

RESULTS

In terms of usefulness score distribution, 53.52% of the videos were considered slightly useful, 38.4% moderately useful and 8.1% very useful. The video content had the least quantity of knowledge about toothpaste choice (11.1%), but the greatest quantity of knowledge on flossing (68.7%).

CONCLUSIONS

According to the study's findings, there is presently no evidence-based information on YouTube™ on dental implant oral hygiene protocols for home care procedures hygiene education. Therefore, dental care professionals should analyse the information's quality and reliability before recommending it to patients.

Management of bleeding during dental implant surgery using a novel implant with an abbreviated drilling protocol: A clinical report

Coagulopathy is a well-recognized complication in dental surgery in patients who use oral anticoagulants or some dietary supplements. Proper pre-operative diagnosis, medical consultation, timely management, and conservative treatment can decrease the incidence of such complications. Management of bleeding during dental implant surgery commonly involves conventional methods such as discontinuation of anticoagulant use, compression, styptics, and local anesthetic administration containing vasoconstrictors. This clinical report describes the successful management of a patient with a history of coagulopathy who was rehabilitated with complete arch fixed implant-supported prostheses with immediate loading. A novel implant design with a significantly abbreviated single drill protocol for osteotomy preparation was used in an outpatient setting. The novel protocol successfully decreased the overall bleeding and significantly reduced the intraoperative time for the surgical procedure. Additional considerations related to the novel implant design and osteotomy protocol, supplementary applications, and advantages of the protocol are presented in this article.

Titanium versus zirconia complete arch implant-supported fixed prostheses: A comparison of plaque accumulation

STATEMENT OF PROBLEM

Complete arch implant-supported zirconia prostheses appear to have less plaque accumulation than titanium prostheses, but a comparison of the materials and the possible influence on the adjacent soft tissue is lacking.

PURPOSE

The purpose of this clinical study was to compare the plaque accumulation and soft-tissue inflammation of complete arch implant-supported fixed maxillary prostheses fabricated with either a titanium framework or monolithic zirconia.

MATERIAL AND METHODS

Twenty participants with a complete arch implant-supported fixed maxillary prosthesis were enrolled in the study. The participants were divided into 2 groups according to the prosthesis material, titanium (Ti) or zirconia (Zir). The prosthesis had to have been in function for at least 6 months, and participants were examined during at least 3 maintenance appointments at 3-month intervals. Clinical information collected in each appointment included standardized photographs to record the Plaque Area Index (PAI) of the intaglio surface of the prosthesis; clinical parameters including modified Plaque Index (mPI), modified Bleeding Index (mBI), implant mobility (MOB), probing depths ≥5 mm (PD), suppuration (SUP), keratinized tissue band ≥2 mm (KT), and an intraoral photograph of the maxillary arch without the prosthesis to evaluate the redness of the soft tissues.

RESULTS

MOB was not present at any implant at any time point. SUP could not be analyzed because it was an infrequent finding. Both groups exhibited significant increases in mBI over time. No significant differences were observed for PD between the groups at any time point. Implants in the Ti group had significantly higher KT values than those in the Zir group; levels remained constant over time for both groups. Zirconia prostheses had slightly lower PAI levels than Ti prostheses. The PAI in the Zir group significantly decreased over time (P=.035); in the Ti group, they remained constant (P=.45). Higher PAI levels were correlated with increased levels of erythema; both groups had a significant decrease in erythema values over time (P=.04).

CONCLUSIONS

Zirconia complete arch implant-supported fixed maxillary prostheses displayed a significant decrease in plaque accumulation in individuals who had received periodic maintenance and oral hygiene instructions. Ti prostheses had significantly higher plaque levels than zirconia prostheses at all time points, which was not reduced by maintenance and oral hygiene measures. The present study suggests that patients receiving zirconia prostheses respond well to plaque control measures, while plaque control for those with titanium prostheses may be more challenging.

Consistency of recommendations of clinical practice guidelines in periodontology: a systematic review

The aim of this systematic review was to evaluate the methodological quality and the consistency of recommendations of clinical practice guidelines (CPGs) in Periodontology. An electronic search was conducted in two databases, MEDLINE and EMBASE, eight CPGs databases, and home pages of scientific societies in Periodontology up to April 2022. Three reviewers independently assessed methodological quality using the AGREE II instrument. In addition, we evaluated the consistency of the recommendations. Eleven CPGs were included, and the topics developed focused on prevention, diagnosis, risk factors, surgical and non-surgical periodontal treatment, antimicrobial therapy, root coverage, and maintenance. We found that the AGREE domains 2 (Stakeholder involvement) and 5 (Applicability) obtained the lowest scores. Domains 1 (Scope and purpose), 3 (Rigor of development) and 4 (Clarity of presentation) obtained the highest scores among the evaluated CPGs. The clinical recommendations for treatment of periodontal diseases were mostly consistent. Overall, the quality of CPGs used in periodontics was high. There was consistency of recommendations in specific fields. These findings may help researchers to promote CPGs focused on different fields of periodontics that have not yet been developed. Furthermore, the clinician will be able to make better clinical decisions.

A Prospective Study to Assess Patients' Understanding and Retention of Postoperative Instructions following a Fixed Partial Denture, Using Different Information Delivery Techniques

OBJECTIVE

 This study was aimed to evaluate the effect of using different modes of at-home maintenance information delivery on patients' understanding and the level of information retention.

MATERIALS AND METHODS

 Sixty patients were asked to answer a questionnaire while undergoing mouth preparations for receiving a fixed partial denture. The questionnaire includes questions related to at-home maintenance procedures and recall visits. After finishing the first questionnaire, these patients were randomly assigned into three groups, and each group was given education about at-home maintenance procedures and recall visits by different means. Group 1 participants were educated by giving live demonstrations. Group 2 participants were shown a prerecorded video, whereas group 3 participants were given written instructions. All Participants were recalled after 1 week of the last visit and were asked to fill out the same questionnaire.

STATISTICAL ANANLYSIS

 Collected data were tabulated in a Microsoft Excel Spreadsheet and were analyzed using the Chi-square test, one-way ANOVA, paired t-test, and post hoc Bonferroni test. A p-Value < 0.05 was regarded as statistically significant for all the analyses.

RESULTS

 Group 1 showed greatest information retention as compared with groups 2 and 3 (p = 0.045). There was significant difference in the knowledge of group 1 as compared with groups 2 (p = 0.020) and 3 (p = 0.048).

CONCLUSION

 The mode of delivering postoperative instructions after fixed partial denture treatment does have an effect on the patient understanding level and information retention. Patients who were given live demonstrations showed the best results compared with video recordings and written leaflets.

Exploring variation of coverage and access to dental care for adults in 11 European countries: a vignette approach

BACKGROUND

Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach.

METHODS

We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists.

RESULTS

Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care.

CONCLUSIONS

According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.

Radiographic Evaluation of Prosthodontic Patients

This article focuses on radiographic imaging with regard to planning, treating, and maintaining partially and completely edentulous prosthodontic patients with dental implants. Cone-beam computed tomography (CBCT) is the preferred imaging method for pretreatment dental implant treatment planning. Radiographic guides containing radiopaque materials and/or fiducial markers transfer both the proposed prosthesis design and desired implant location for appropriate radiographic evaluation. The three-dimensional CBCT analysis provides information on the adjacent relevant anatomy, bone volume of the edentulous sites, and restorative space assessment.

Prosthetic rehabilitation of meth mouth with implant-supported fixed dental prostheses: A clinical report

This clinical report describes the prosthetic restoration of a failing dentition subsequent to methamphetamine abuse. The treatment involved the use of endosteal dental implants and milled cobalt-chromium, screw-retained, implant-supported fixed dental prostheses. At the 1-year follow-up, the prosthetic rehabilitation had markedly improved the patients' health, esthetics, and function.

Can we improve dental treatment outcomes in patients with high-risk factors?

Aim The aim of the study was to identify best practice in relation to improving the periodontal conditions of patients and increasing the rate of treatment success, through the identification of risk factors and implementation of changes in lifestyle.Methods and materials The study used two search strategies to identify papers describing best practices and important lifestyle changes which improved periodontal conditions and treatment outcomes in patientsResults The study demonstrated that the two most important factors in terms of interventions to improve periodontal conditions and treatment outcomes were to improve the level of diabetes control and remove aggravating factors such as smoking.Conclusion Many studies have focused on improving treatment outcomes in patients with high-risk factors such as smoking and medical conditions. Strategies, guidelines and protocols that reflect the best practices and lifestyle changes to improve the level of treatment success in high-risk patients should be adapted within treatment planning and follow-up. Successful treatment outcomes are best achieved through controlling diseases affecting the oral cavity and supporting structures.

Dentists' preferences in implant maintenance and hygiene instruction

BACKGROUND

This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI).

METHODS

General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency.

RESULTS

Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures.

CONCLUSIONS

Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.

Single-implant mandibular overdentures: Clinical, radiographic, and patient-reported outcomes after a 5-year follow-up

STATEMENT OF PROBLEM

Previous studies on single-implant mandibular overdentures have reported favorable results for clinical and patient-reported outcomes. However, information from longer term clinical studies is lacking.

PURPOSE

The purpose of this clinical study was to assess clinical, radiographic, and patient-reported outcomes of edentulous individuals rehabilitated with single-implant mandibular overdentures after a 5-year follow-up.

MATERIAL AND METHODS

A prospective clinical study was performed including completely edentulous individuals who received new conventional complete dentures and then an external hexagon implant in the mandibular midline region, followed by the incorporation of a retention system (O-ring/ball attachment; Neodent). Data collection occurred at baseline and 3, 6, 12, 24, and 60 months after implant loading. Assessed outcomes included implant stability, peri-implant soft tissue condition, peri-implant marginal bone level, satisfaction with the prostheses, and oral health-related quality of life (OHRQoL). Clinical maintenance events were also recorded. Descriptive statistics, incidence rates, Wilcoxon Signed Ranks test, and Generalized Estimating Equation regression were used for data analysis (α=.05).

RESULTS

Thirty of 34 eligible participants attended the 5-year follow-up visit, mean ±standard deviation age was 68.1 ±7.8 years, and 70% were women. The overall implant survival rate was 88.9%. After 5 years, the OHRQoL showed statistically significant improvement for all evaluation periods compared with baseline (P<.001). Regarding satisfaction with the mandibular denture, a significant increase was found between all evaluation periods compared with baseline in terms of comfort, stability, and ability to masticate (P<.001). Implant stability significantly increased (P=.003), and a mean bone loss of 1.46 mm was observed compared with baseline measures. The most frequent maintenance event was replacement of the O-ring matrix (n=80). Twenty-one midline fractures of the overdenture occurred in 14 study participants. No significant changes in peri-implant soft tissue conditions were observed.

CONCLUSIONS

A single-implant mandibular overdenture effectively maintained the positive effect of the intervention on oral health-related quality of life and patient satisfaction, stable peri-implant condition, and acceptable rates of prosthetic events.

Implant survival and biologic complications of implant fixed complete dental prostheses: An up to 5-year retrospective study

STATEMENT OF PROBLEM

Limited information is available on the association between prosthesis-associated risk factors and biologic complications for patients with implant fixed complete dental prostheses (IFCDPs).

PURPOSE

The purpose of this retrospective study was to assess the implant survival and biologic complications of IFCDPs up to 5 years of follow-up.

MATERIAL AND METHODS

Patients who had received IFCDPs between August 1, 2009 and August 1, 2014 were identified through an electronic health record review. Those who consented to participate in the study attended a single-visit study appointment. Clinical and radiographic examinations, intraoral photographs, and peri-implant hard and soft tissues parameters were assessed. Only prostheses which could be removed during the study visit were included. Associations between biologic complications and prosthetic factors, such as time with prosthesis in place, prosthesis material, number of implants, cantilever length, and type of prosthesis retention, were assessed.

RESULTS

A total of 37 participants (mean ±standard deviation age 62.35 ±10.39 years) with 43 IFCDPs were included. None of the implants had failed, leading to an implant survival of 100% at 5.1 ±2.21 years. Ten of the prostheses were metal-ceramic (Group MC) and 33 were metal-acrylic resin (Group MR). Minor complications were more frequent than major ones. Considering minor complications, peri-implant mucositis was found in 53% of the implant sites, more often in the maxilla (P=.001). The most common major biologic complication was peri-implantitis, which affected 4.0% of the implants, more often in the mandible (P=.025). Peri-implant soft tissue hypertrophy was present 2.79 times more often (95% CI: 1.35 - 5.76, P<.003) around implants supporting metal-acrylic resin prostheses than metal-ceramic ones, with the former type also showing significantly more plaque accumulation (P<.003).

CONCLUSIONS

Biologic complications such as soft tissue hypertrophy and plaque accumulation were more often associated with metal-acrylic resin prostheses. Peri-implant mucositis occurred more often under maxillary IFCDPs, while peri-implantitis appeared more common around mandibular implants.

Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants

Background

This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry.

Materials and Methods

A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to “Esthetics,” “Self-Assessment or Surveys and Questionnaires,” and “Single-Tooth Dental Implants.”

Results

The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri‐Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development.

Conclusions

Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

Awareness and management of peri-implantitis and peri-mucositis among private dental Practitioners in Hyderabad - A cross-sectional study

Background:

Implant therapy, in India, has flourished in recent years and is being practiced widely by many dental practitioners today. Along with the increasing number of implants being placed today, there has also been a constant rise in the number of complications associated with it.

Objectives:

The aim of this study is to evaluate the knowledge and awareness of implant placement and management of peri-implant diseases among dental professionals.

Materials and Methods:

A total of 568 dental practitioners were approached with a questionnaire for collecting data related to demographic details, experience, and knowledge about implant placement and management of its complications. Of these, only 262 were included as part of the statistical analysis. This data collected were compiled and analyzed using descriptive statistics.

Results:

Results showed that most dentists who participated in this study have adequate knowledge about etiological factors and its management. Those who acquired implant skills through sources that are not in accordance with accepted standards had unsatisfactory knowledge and practice behavior.

Conclusion:

The awareness and knowledge regarding the implant procedures and their complications such as peri-implant mucositis and peri-implantitis were higher in self-trained dentists and by dentists who are practicing for >10 years and calls for updating of knowledge.

Changing the Focus to the Whole Patient instead of One Oral Disease: The Concept of Individualized Prevention

Oral diseases are highly prevalent and a global burden. Accordingly, their prevention appears essential. Recently, different strategies have been developed, mainly focusing on the presence of singular oral diseases or conditions. This article aims to construct a contemporary concept of individualized preventive care in dentistry whereby the focus is switched from viewing oral health in isolation to viewing the patient as a whole. The basis for individualized prevention measures is the case-oriented profile, including the synthesis of risk- and need-oriented parameters. The risk profile comprises different risk factors within the fields of systemic diseases, medications, and lifestyle that inherently pose a potential risk of complications (e.g., infectious endocarditis) and/or oral diseases (e.g., periodontitis). The needs profile includes factors originating from the aspects of oral diseases, dental restorations/appliances, and dental results with a potential risk of pathogenesis (e.g., the de novo development of caries) and/or the potential progression of oral diseases (e.g., an existing caries lesion). Based on these parameters, the general framework and content of prevention measures, as well as the maintenance interval, should be adapted to the individual patient. The implications of this concept might increase the safety, effectiveness, and efficiency of prevention in dental care. A further area of focus is primary prevention, that is, a focus on the preservation of oral health instead of a disease-related approach. However, clinical validation is needed to prove the benefits of the model presented. Individualized prevention promotes a shift from a disease-focused model to a whole-patient-focused model and provides a potential approach for establishing a contemporary concept for preventive care in dentistry.

Dental implant maintenance teaching in Australia-A survey of education providers

INTRODUCTION

Implant treatments and peri-implant maintenance continue apace, while the evidence for implant maintenance and home hygiene continues to be developed. Information sources for dental practitioners and patients in peri-implant health maintenance and disease management are generally not known. This study investigated the implant maintenance topics taught, the discipline backgrounds of convenors and presenters and information delivery methods within implant dentistry teaching in Australia.

MATERIALS AND METHODS

An online survey was distributed to 56 convenors of implant dentistry and maintenance education programmes in Australia, garnering responses from 24 individuals which outlined 43 different education programmes.

RESULTS

Lectures were the main delivery method for implant maintenance information across the different course types. Peri-implant diagnostics were generally taught according to current literature recommendations, but coverage varied in topics where the evidence is yet to be established (eg home hygiene, professional maintenance and implant review). Some educators reported awareness of limitations in their programmes.

CONCLUSION

Implant dentistry education programmes in Australia vary widely in teaching implant maintenance, coverage of which should be current and evidence-based at all education levels. The structure of implant dentistry teaching at the continuing professional development level requires further development.

Role of Dental Implant Homecare in Mucositis and Peri-implantitis Prevention: A Literature Overview

Background:

Correlation between high plaque index and inflammatory lesions around dental implants has been shown and this highlights the importance of patient plaque control. Until now, knowledge of peri-implant home care practices has been based on periodontal devices.

Objective:

The aim of this overview is to identify the presence of scientific evidence that peri-implant homecare plays a role in mucositis and peri-implantitis prevention.

Methods:

Different databases were used in order to detect publications reflecting the inclusion criteria. The search looked into peri-implant homecare studies published from 1991 to 2019 and the terms used for the identification of keywords were: Dental implants, Brush, Interproximal brushing, Interdental brushing, Power toothbrush, Cleaning, Interdental cleaning, Interspace cleaning, Flossing, Super floss, Mouth rinses, Chlorhexidine. The type of studies included in the selection for this structured review were Randomized Clinical Trials, Controlled Clinical Trials, Systematic Reviews, Reviews, Cohort Studies and Clinical cases.

Results:

Seven studies fulfilled all the inclusion criteria: 3 RCTs, one Consensus report, one cohort study, one systematic review and one review. Other 14 studies that partially met the inclusion criteria were analyzed and classified into 3 different levels of evidence: good evidence for RCTs, fair evidence for case control and cohort studies and poor evidence for expert opinion and case report.

Conclusion:

Not much research has been done regarding homecare implant maintenance. Scientific literature seems to show little evidence regarding these practices therefore most of the current knowledge comes from the periodontal literature. Manual and powered toothbrushes, dental floss and interdental brushes seem to be useful in maintaining peri-implant health. The use of antiseptic rinses or gels does not seem to have any beneficial effects.

It can be concluded that to better understand which are the most effective home care practices to prevent mucositis and peri-implantitis in implant-rehabilitated patients, new specific high evidence studies are needed.

Biofilm as a risk factor in implant treatment

This article summarizes the microbiological findings at dental implants, drawing distinctions between the peri-implant microbiome and the periodontal microbiome, and summarizes what is known regarding biofilm as a risk factor for specific stages of implant treatment. Targeted microbial analysis is reviewed as well as the latest results from open-ended sequencing of the peri-implant flora. At this time there remains a lack of consensus for a specific microbial profile that is associated with peri-implantitis, suggesting that there may be other factors which influence the microbiome such as titanium surface dissolution. Therapeutic interventions to address the biofilm are presented at the preoperative, perioperative, and postoperative stages. Evidence supports that perioperative chlorhexidine reduces biofilm-related implant complications and failure. Regular maintenance for dental implants is also shown to reduce peri-implant mucositis and implant failure. Maintenance procedures should aim to disrupt the biofilm without damaging the titanium dioxide surface layer in an effort to prevent further oxidation. Evidence supports the use of glycine powder air polishing as a valuable adjunct to conventional therapies for use at implant maintenance visits. For the treatment of peri-implantitis, nonsurgical therapy has not been shown to be effective, and while surgical intervention is not always predictable, it has been shown to be superior to nonsurgical treatment for decontamination of the implant surface that is not covered by bone.

Interdisciplinary treatment with implant-supported prostheses for an adolescent with ectodermal dysplasia: A clinical report

This clinical report describes interdisciplinary treatments for a 17-year-old girl with ectodermal dysplasia. The treatment was initiated with orthodontic therapy. After the remaining primary teeth had been extracted, 6 implants were placed in the maxilla with bilateral sinus floor elevations, and 6 implants were placed in the mandible. Immediate restorations were provided. Definitive restorations included screw-retained partial dental prostheses and ceramic crowns.

Implant-Supported Immediately Loaded Complete Arch Rehabilitations with a Mean Follow-up of 10 Years: A Prospective Clinical Study

PURPOSE

To evaluate the complication-free and failure-free survival rates of porcelain fused to zirconia (PFZ) and all-resin complete arch fixed implant-supported prostheses over a mean follow-up of 10 years.

MATERIAL AND METHODS

Subjects with either all-resin or PFZ complete arch fixed implant-supported prostheses on 4 or 6 implants were followed prospectively for 10 years. Cumulative survival rates of prostheses without any catastrophic mechanical complications (resolved without replacing the prosthesis) and free of prosthesis failure (requiring the replacement or removal of the prosthesis) were calculated using life table analysis for up to 10-year period. Additional descriptive variables for various prosthesis events were recorded, such as sex, smoking and drinking status of subjects.

RESULTS

A total of 36 subjects with a total of 68 prostheses (53 all-resin and 15 PFZ) were available for evaluation with a mean follow-up of 10 years (SD 1.47; range: 8-13 years). The study registered an overall 90% prostheses survival rate-78% for males and 94% for females; 91% for PFZ and 87% for all-resin; and a 31% complication-free prosthesis survival rate-13% for males and 38% for females; 29% for PFZ and 31% for all-resin at 10 years. A slight decrease in survival rate was identified in the first 3 years since the initial treatment (from 100% to 93%). The number of complications increased with time, especially after the 6th year after the initial treatment.

CONCLUSION

Despite the number of reparable mechanical complications, the results confirmed the long-lasting features of both PFZ and all-resin complete arch fixed implant-supported prostheses over a 10-year period. There was however an increased number of mechanical complications after 6 years which may entail additional treatment cost for patients.

Patient-Specific, Risk-Based Prevention, Maintenance, and Supportive Care: A Need for Action and Innovation in Education

PURPOSE

To develop a competency-based curriculum framework for prevention, supportive care, and maintenance for use in educational and patient care programs and to seek consensus on an overarching competency statement that embraces these critical learning and patient care concepts.

MATERIALS AND METHODS

A preliminary survey of current preventive and maintenance practices in U.S. dental and prosthodontic programs was completed and summarized with quantitative analysis. The American College of Prosthodontists organized a one-day consensus workshop with 14 participants from various U.S. dental schools with diverse backgrounds to develop a curriculum framework. The curriculum framework was used in the development of a joint competency statement using an iterative, online consensus process of debate and feedback.

RESULTS

The preliminary survey helped frame the initiative and identify potential educational needs and gaps. Consensus was achieved for a recommended competency statement: "Graduates must be competent in promoting oral health through risk assessment, diagnosis, prevention, and management of the hard tissue, soft tissue, and prostheses, and as part of professional recall and home maintenance." This competency statement complements the proposed curriculum framework designed around 3 domains-caries prevention, periodontal supportive care, and prosthesis supportive care-with a set of recommended learning objectives.

CONCLUSIONS

Commission on Dental Accreditation (CODA) learning standards do not outline patient-customized, evidence-based recall and home maintenance programs that highlight prevention of dental caries, periodontal supportive care, prosthesis maintenance, and patient education. The proposed competency-based curricular framework serves as an initial step in addressing student learning and patient care within the context of a recall system and home maintenance program while offering schools the needed flexibility for implementation within their curriculum.

Management of peripheral giant cell granuloma around complete-arch fixed implant-supported prosthesis: A case series

Abnormal peri-implant tissue response in the form of benign reactive lesions, such as peripheral giant cell granuloma and pyogenic granuloma, is a less frequent biologic complication associated with dental implant therapy. However, these lesions can cause gingival pain, swelling, and discomfort, as well as peri-implant bone loss and possible implant failure. Few reports in the dental literature have described these lesions around complete-arch fixed implant-supported prostheses. The purpose of this clinical report was to describe 3 distinct scenarios in patients with complete-arch fixed implant-supported prostheses presenting with benign reactive lesions that were histologically diagnosed as peripheral giant cell granulomas. Each of these 3 patients had acrylic resin as one of the materials in their prosthesis. The distinctive management of each of these 3 patients encompassed surgical, prosthodontic, and pharmacologic means.

A Peri-Implant Disease Risk Score for Patients with Dental Implants: Validation and the Influence of the Interval between Maintenance Appointments

Background: There is a need for tools that provide prediction of peri-implant disease. The purpose of this study was to validate a risk score for peri-implant disease and to assess the influence of the recall regimen in disease incidence based on a five-year retrospective cohort. Methods: Three hundred and fifty-three patients with 1238 implants were observed. A risk score was calculated from eight predictors and risk groups were established. Relative risk (RR) was estimated using logistic regression, and the c-statistic was calculated. The effect/impact of the recall regimen (≤ six months; > six months) on the incidence of peri-implant disease was evaluated for a subset of cases and matched controls. The RR and the proportional attributable risk (PAR) were estimated. Results: At baseline, patients fell into the following risk profiles: low-risk (n = 102, 28.9%), moderate-risk (n = 68, 19.3%), high-risk (n = 77, 21.8%), and very high-risk (n = 106, 30%). The incidence of peri-implant disease over five years was 24.1% (n = 85 patients). The RR for the risk groups was 5.52 (c-statistic = 0.858). The RR for a longer recall regimen was 1.06, corresponding to a PAR of 5.87%. Conclusions: The risk score for estimating peri-implant disease was validated and showed very good performance. Maintenance appointments of < six months or > six months did not influence the incidence of peri-implant disease when considering the matching of cases and controls by risk profile.

A 30-Year Follow-Up of a Patient with Mandibular Complete-Arch Fixed Implant-Supported Prosthesis on 4 Implants: A Clinical Report

Mandibular complete-arch fixed implant-supported prostheses are recognized as one of the earliest and most popular prostheses in implant dentistry. This prosthesis was the main focus in the early era of osseointegration. Despite its widespread popularity, few clinical reports have described long-term follow-up greater than 10 years for this type of prosthesis. This report describes a 30-year follow-up of a patient who underwent treatment for a mandibular complete-arch fixed implant-supported prosthesis with 4 machined surfaced implants, opposing a maxillary complete denture. This report documents a variety of photographs and radiographs taken over a period of 30 years to compare bone levels at various stages of care and maintenance, including de novo bone formation underneath the distal cantilevers due to functional loading. The biologic and biomechanical response to this treatment protocol and long-term clinical observations and prosthodontic outcome and maintenance needs are also addressed.

Shark Fin Titanium Hollow Bulb Obturator: A Treatment Concept

Restoring esthetics and function for patients with maxillectomy defects presents a complex challenge for the clinician. Obturator prostheses are subject to rotational forces during function, allowing movement into the defect. Gaining prosthesis support from endosseous implants can limit the amount of rotation. Xerostomia and impaired tissue healing caused by radiation therapy further complicates the treatment for such patients. Several resilient and rigid obturator design concepts are available for restoration of such defects. This clinical report describes a design concept used to treat a patient with a maxillectomy defect caused by tumor resection secondary to a squamous cell carcinoma.

Patient-Reported and Clinical Outcomes of Implant-Supported Fixed Complete Dental Prostheses: A Comparison of Metal-Acrylic, Milled Zirconia, and Retrievable Crown Prostheses

The purpose of this retrospective study was to assess the incidence of biologic and technical complications for implant-supported fixed complete dental prostheses (IFCDPs) and their relationship to oral health-related quality of life (OHQoL) and patient-reported outcomes. Metal-acrylic (MA), retrievable crown (RC), monolithic zirconia (MZ), and porcelain veneered zirconia (PVZ) prostheses were included. Patients who received an IFCDP at least 1 year prior to recall were identified. Exclusion criteria were: (1) an opposing complete denture and (2) time in service &gt;70 months. A total of 37 patients with 49 prostheses, including 22 MA, 14 RC, 7 MZ, and 6 PVZ prostheses were recalled. Patient-reported outcomes were assessed via OHIP-49 (Oral Health Impact Profile) and a scripted interview with open-ended questions. All designs had high complication rates (12 of 22 MA, 10 of 14 RC, 2 of 7 MZ, and 5 of 6 PVZ). The most common complications were: (1) MA: posterior tooth wear, (2) RC: chipping and fracturing of the restorations, (3) MZ: wear of opposing restorations, and (4) PVZ: chipping of opposing restorations. Average OHIP-49 scores ranged from 7 to 29, indicating high OHQoL, patient satisfaction, regardless of prosthetic design (P = .16). The standardized interview highlighted that although most patients were extremely satisfied (73%), some continued to be bothered by material bulk (14%) and felt that maintenance of oral hygiene was excessively time-consuming (16%). In the context of this study, despite high complication rates and maintenance needs, all IFCDP designs resulted in high OHQoL and patient satisfaction.

Aspects of Malpractice in Prosthodontics

Crowns, fixed partial dentures, and removable dentures are the popular prosthetic dental restorations in current dental practice. Prosthodontic rehabilitation of the mouth, particularly in advanced and complex cases, requires careful planning, adequate clinical skills, and exacting technical standards. While a successful outcome is the ultimate goal for any prosthodontic treatment, complications, injuries, dissatisfaction, and/or failure may occur. When such events develop as a result of negligence or violation of standards of care, they are considered under the term of malpractice and may incur ethical and medico-legal implications. This paper reviews and highlights some aspects of malpractice in prosthodontics. The current state of prosthodontic malpractice on a global level will also be evaluated. Standards of prosthodontic care, current literature of prosthodontic malpractice, where and how prosthodontic malpractice occurs, and recommendations for the future are presented. A thorough understanding of what is quality prosthodontic care and what disrupts this care can be a useful guard against professional litigation and may protect patients from poor quality of dental prosthetic care.